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Michigan rates for HCPCS 15769

Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$565.71 / $712.79 / $6,388.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.40 / $548.29 / $769.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,389.51 / $4,633.17 / $10,684.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.51 / $726.55 / $808.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.21 / $540.41 / $1,890.78
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.52 / $575.89 / $6,906.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.98 / $511.74 / $765.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.44 / $377.25 / $582.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,296.00 / $7,780.00 / $10,556.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.19 / $581.99 / $791.18